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California rates for HCPCS Q4183

surgiGRAFT, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.00 / $83.00 / $83.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.00 / $83.00 / $85.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.84 / $98.63 / $166.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $95.00 / $201.45
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.20 / $100.00 / $1,450.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.00 / $638.07 / $801.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $200.00 / $375.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.00 / $380.00 / $450.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.00 / $85.00 / $85.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.00 / $100.00 / $100.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $85.00 / $120.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.91 / $160.91 / $305.55